VEMPs and dynamic posturography after intratympanic gentamycin in Menière's disease

In this study, we investigated whether vestibular evoked myogenic potentials (VEMPs) and dynamic posturography (DP) are useful in the evaluation of the vestibular function in patients affected by active monoaural Menière's disease (MD) treated with intratympanic gentamycin. Twelve subjects affected by monoaural MD were treated with weekly intratympanic injections of 0.5 ml of gentamycin at a concentration of 20 mg/ml. VEMPs were used to test saccular function, while postural control was analyzed by DP. The results obtained with these two techniques were compared with those obtained by using bithermal caloric test. The mean follow-up was 15.3 months (6--28 months). Therapy resulted in complete absence of the caloric response in six subjects (50) and in caloric test-induced asymmetry in the remaining individuals, ranging from 83 to 27. At follow-up, eleven patients (91.6%) were free of vertigo, while one patient had two vertigo spells 9 months after treatment. Before treatment, VEMPs were present in the affected ear of eleven patients. After treatment VEMPs were absent in all the patients. At the end of follow-up, reappearance of VEMPs was observed in two patients, with no changes in latency values and amplitude ratio. DP demonstrated a reduction of the Composite Score (CS) one week after therapy, with a prevalent reduction of the vestibular component. After 6 months, there was an improvement of the CS and, in particular, of the vestibular component. The present study demonstrates that bithermal caloric test and VEMPs allow for the functional evaluation of both the horizontal semicircular canal and the sacculus, suggesting that these techniques might be used together to monitor the efficacy of intratympanic gentamycin therapy. In addition, our data indicate that DP might provide important information on compensation phenomena and show that intratympanic gentamycin can improve postural control in MD patients.     

Balance Rehabilitation Unit (BRU™) posturography in benign paroxysmal positional vertigo

Posturography has been used in the evaluation of patients with vestibular disorders.AimTo evaluate balance control with the Balance Rehabilitation Unit (BRU?) posturography in patients with Benign Paroxysmal Positional Vertigo. Study design: Prospective case-control.Materials and MethodsA cross-sectional controlled study was carried out in 45 patients with BPPV, and a homogeneous control group consisting of 45 healthy individuals. Patients were submitted to a balance function evaluation by means of the Balance Rehabilitation Unit (BRU?) posturography.ResultsThe mean values of the ellipse area and the sway velocity in a firm surface and saccadic stimulation (p = 0.060).ConclusionThe Balance Rehabilitation Unit (BRU?) posturography enables to identify postural control abnormalities in patients with BPPV.     

Class A results in Menière's disease.

A series of 101 patients with Menière's disease treated surgically with an intramastoid endolymphatic shunt operation and with a minimum follow-up of 2 years is reported. The results included success in 76 percent and failure in 22 percent. Thirteen of these patients maintained a hearing level of 15 dB or better, while 11 patients experienced hearing gains of 25 dB or better. These results are compared to other reports, and the difficulty of making such comparisons is illustrated. A derived "efficacy ratio" is defined, and its use is suggested to aid in making statistical inference. The conclusion is reached that more knowledge is required about the natural history of Menière's disease so that appropriate staging may be carried out on these study populations.     

Aldosterone assessment in patients with Menière's disease

Since 1938 endolymphatic hydrops has generally been accepted as the basic histopathological substrate of Menière's disease. In animal studies it has been found that exogenous administration of aldosterone resulted in endolymphatic hydrops. Manifestations of Menière's disease are frequently observed in times of emotional stress. Mediated through the hypothalamus, stress leads to an increased secretion of adrenocorticotropic hormone from the anterior pituitary gland, followed by an increased adrenocortical production of glucocorticoids (cortisol and corticosterone) and mineralocorticoids (aldosterone). We addressed the question whether plasma aldosterone levels, like in guinea pigs, would be increased in patients with Menière's disease. As part of a diagnostic protocol a clinical prospective cohort study was therefore performed on 89 patients with Menière's disease to assess plasma aldosterone levels. Plasma aldosterone was not elevated in Menière patients compared to plasma aldosterone in a control group of 27 normal subjects. No statistically significant differences were found in plasma aldosterone between uni- and bilateral Menière's disease. Plasma aldosterone levels did not correlate with age, average hearing loss, duration or perceived severity of subjective complaints (vertigo, hearing loss, tinnitus and aural pressure). In this study plasma aldosterone was not elevated in patients with Menière's disease compared to normal subjects. Plasma aldosterone can thus not be used as a diagnostic tool for Menière's disease. In conclusion: No anomalous plasma aldosterone levels were found in Menière patients during an attack-free period. The question whether plasma aldosterone and cortisol levels show variations before, during and after an attack remains to be answered. If so, this might contribute to a better understanding of the pathophysiological mechanism of Menière's disease.     

Unstable distortion-product otoacoustic emission phase in Menière's disease

The presence of endolymphatic hydrops as a marker of Menière's disease (MD) suggests abnormal pressure in the intralabyrinthine compartments of patients and excessive stiffness of sound-sensitive structures. Otoacoustic emissions (OAEs) have been reported to respond to changes in the ear's stiffness, including those produced by intracranial pressure steps, by a characteristic phase shift around 1?kHz, thereby suggesting a noninvasive means of monitoring MD. Here, body tilt was used for modulating intracranial pressure in forty-one patients with definite MD who were tentatively measured at two stages, with and without active symptoms. Their distortion-product OAEs (DPOAEs) were dynamically monitored around 1?kHz every few seconds in response to body tilt. In a control sample of thirty normal ears, the maximum phase rotation of DPOAEs produced by body tilt was between -18° and?+37°. In MD ears with the complete set of symptoms, the posture-induced phase shifts in 32 out of 35 tests fell outside the normative interval, and in 10 tests, although DPOAEs were well above noise floor, their phase was always so abnormally erratic that body tilt produced hardly any additional effect. When MD ears were asymptomatic, nine out of 32 posture tests were abnormal. The excessive DPOAE phase shift is consistent with either a too stiff cochlear partition or a displacement of the operating point of outer hair cells by endolymphatic hydrops.     

Middle ear overpressure treatment in severe Menière's disease

To evaluate the therapeutic effect of middle ear pressure pulse on endolymphatic hydrops in humans, Meniett20k was used for 12 months in two severe elderly patients with definite Meniere's disease. The average number of vertigo occurrences in the 6 months before treatment and in the 12 months after treatment started was compared. Numeric values (NV) among patients were calculated and categorized into an improved group (NV = 1-40). For hearing function, the pure-tone average (PTA) before and 12 months after treatment started was compared. PTA was calculated based on the following equation: PTA = (A + 2XB + C)/4. A, B, and C were thresholds of the pure-tone audiometory at 0.5, 1.0, and 2.0 kHz. In one case, hearing function was unchanged, but deteriorated in the other. Pressure pulse treatment may thus be useful in severe cases of Meniere's, especially in the elderly, bilateral cases, and in endolymphatic hydrops in a single hearing ear.     

Factors associated with quality of life in Menière's disease

The aim of this study was to identify the factors associated with better or worse quality of life in a sample of people with Menière's disease drawn from a UK self-help group (the Menière's Society) and to assess the forms of support on which the respondents could draw. A postal survey was sent to 1000 randomly selected group members, containing validated questionnaires assessing: (1) quality of life (the Short Form 36 (SF-36)); (2) factors that might predict quality of life; and (3) usage of resources provided to members by the Menière's Society. A total of 509 members completed the main survey, and 370 the second part of the survey. Factors associated with a less good quality of life included more severe vertigo, pressure in the ear, hearing loss and tinnitus, being younger, being female, living alone, having a lower occupational status and believing that the attitude of the consultant is unhelpful. Levels of vertigo severity in this sample were similar to those found in hospital samples, but it is possible that these respondents may differ in other respects from patients who do not join a self-help group.     

Critical Bandwidth in Menière's Disease

The critical bandwidth in loudness summation was estimated in 20 patients with typical Menière's disease using noise bands centered around 1 kHz. A reduction of the normal loudness difference between broad-band noise and narrow-band noise was present at all except the highest levels. Judged individually, 7 of the 20 patients appeared to have a widened critical band, but in the pooled data the size of the critical band was normal. This was the case in patients with a hearing loss <50 dB HL as well as in patients with a hearing loss ≥50 dB HL. Expressed in terms of the critical band mechanism as an internal filter system, the single filter appears to have normal bandwidth but the interaction between adjacent filters is defective. The anatomical localisation of this interaction is discussed.     

Psychological assessment of patients with Menière's disease

The objective of this study was to evaluate daily stressors, coping, personality, physical and mental health, and quality of life in Menière patients. 110 consecutive patients with definite Menière's disease were assessed using the Dutch Daily Hassles List, Coping Inventory for Stressful Situations (CISS), Symptoms Checklist 90 (SCL-90), NEO Five Factor Inventory (NEO-FFI), General Health Questionnaire (GHQ-12), and the Short Form Health Survey 36 (SF-36). Duration and subjective severity of symptoms were scored using a self-report questionnaire. It was shown that Menière patients had more daily stressors, used certain coping strategies less often, and had more psychopathology (e.g. anxiety and depression), and a worse quality of life compared to healthy reference groups. No abnormalities in personality were found. Patients with more severe symptoms had more psychopathology and a worse quality of life than patients with mild symptoms. The psychological profile of Menière patients seems comparable to patients with other chronic diseases. The outcomes should be used to intensify psychological support in patients with this disabling disease.

Sumario

El objetivo de este estudio fue evaluar los factores de estrés cotidiano, la capacidad de manejo de problemas, personalidad, salud física y mental, y calidad de vida en pacientes con Menière. Se evaluaron 110 pacientes con enfermedad de Menière confirmada utilizando la Lista Holandesa de Problemas Diarios, el Inventario de Manejo de Situaciones Tensinógenas (CISS), el Listado 90 de Síntomas (SCL-90), el Inventario NEO de Cinco Factores (NEO-FFI), el Cuestionario General de Salud (GHQ-12) y la Encuesta de Salud de Fórmula Corta 36 (SF-36). Se anotó la duración y la severidad relativa de los síntomas usando un cuestionario de auto-reporte. Se mostró que los pacientes con Menière tenían más factores cotidianos de estrés, utilizaban menos a menudo ciertas estrategias para enfrentar dificultades, y tenían más psico-patología (p.e., ansiedad y depresión) y una peor calidad de vida que los grupos saludables de referencia. No se encontraron anormalidades de personalidad. Los pacientes con síntomas más severos tenían más psico-patología y peor calidad de vida que los pacientes con síntomas leves. El perfil psicológico de los pacientes con Menière parece comparable el de pacientes con otras enfermedades crónicas. Los resultados pueden utilizarse para intensificar el apoyo psicológico a los pacientes con esta enfermedad tan discapacitante.     

Psychological assessment of patients with Menière's disease

The objective of this study was to evaluate daily stressors, coping, personality, physical and mental health, and quality of life in Menière patients. 110 consecutive patients with definite Menière's disease were assessed using the Dutch Daily Hassles List, Coping Inventory for Stressful Situations (CISS), Symptoms Checklist 90 (SCL-90), NEO Five Factor Inventory (NEO-FFI), General Health Questionnaire (GHQ-12), and the Short Form Health Survey 36 (SF-36). Duration and subjective severity of symptoms were scored using a self-report questionnaire. It was shown that Menière patients had more daily stressors, used certain coping strategies less often, and had more psychopathology (e.g. anxiety and depression), and a worse quality of life compared to healthy reference groups. No abnormalities in personality were found. Patients with more severe symptoms had more psychopathology and a worse quality of life than patients with mild symptoms. The psychological profile of Menière patients seems comparable to patients with other chronic diseases. The outcomes should be used to intensify psychological support in patients with this disabling disease.